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Nurse Utilization and Clinical Advisor Services Analyst II
2 weeks ago
Our team at Conduent is dedicated to delivering crucial services and solutions for top-tier companies and numerous governments, positively impacting our clients and the individuals they serve. Join us and thrive personally, make a difference, and become part of a culture that genuinely appreciates and values diversity.
Job Track Description:
- Formal education and expertise in professional, sales, or technical fields required.
- Engages in technical activities.
- Contributes to and oversees projects.
- Uses deductive reasoning to solve issues and offer recommendations.
- Collaborates with key stakeholders.
- Applies past knowledge to achieve results.
- Capable of working independently.
- Must hold a college or university degree.
General Profile
- Possesses knowledge and experience in the field.
- Will develop advanced knowledge and skills.
- Gains an understanding of company processes and customers.
- Uses established procedures to solve standard problems.
- Receives guidance and direction as needed.
Functional Knowledge
- Requires in-depth conceptual understanding of theories, practices, and procedures.
Business Expertise
- Utilizes knowledge of key business drivers effectively.
Impact
- Sets an example for the team through quality service and information delivery.
- Operates within established guidelines and policies.
Leadership
- No supervisory duties involved.
- Offers informal guidance to new team members.
Problem Solving
- Applies existing procedures to resolve common problems.
- Analyzes information to make decisions based on standard practices.
Interpersonal Skills
- Effectively exchanges complex information and ideas.
Responsibility Statements
- Applies medical judgment to case/claim adjudication.
- Reviews denial reconsideration and appeal requests.
- Manually assesses claims for care or coverage appropriateness.
- Collaborates with clients to provide input as per program requirements.
- Coordinates with clinical reviewers for case/claim resolution.
- Performs assigned duties efficiently.
- Adheres to all policies and standards.
Additional Information
- Active Registered Nurse license required.
Conduent is an Equal Opportunity Employer and evaluates all applicants for positions impartially, regardless of various factors protected by law.
For individuals with disabilities requiring accommodations to apply for roles at Conduent, please follow the provided procedure without the need for external links. We prioritize the health and safety of our team, their loved ones, and the wider community, and while COVID-19 vaccination is not mandatory for most positions, disclosing your vaccination status when legally permissible is a mandatory employment requirement at Conduent.
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